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Tytuł:
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The critical importance of pharyngeal contractile forces on the validity of intrabolus pressure as a predictor of impaired pharyngo-esophageal junction compliance.
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Autorzy:
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Szczesniak MM; Department of Gastroenterology and Hepatology, St George Hospital & University, Kogarah, NSW, Australia.
Wu PI; Department of Gastroenterology and Hepatology, St George Hospital & University, Kogarah, NSW, Australia.
Maclean J; Department of Speech Pathology, St George Hospital, Sydney, NSW, Australia.
Omari TI; School of Medical Science, Flinders University, Adelaide, SA, Australia.
Cook IJ; Department of Gastroenterology and Hepatology, St George Hospital & University, Kogarah, NSW, Australia.
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Źródło:
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Neurogastroenterology and motility [Neurogastroenterol Motil] 2018 Oct; Vol. 30 (10), pp. e13374. Date of Electronic Publication: 2018 May 24.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Original Publication: Osney Mead, Oxford, UK : Blackwell Scientific Publications, c1994-
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MeSH Terms:
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Deglutition Disorders/*diagnosis
Esophageal Sphincter, Upper/*physiopathology
Esophageal Stenosis/*diagnosis
Manometry/*methods
Aged ; Antineoplastic Agents/adverse effects ; Deglutition Disorders/etiology ; Deglutition Disorders/physiopathology ; Electric Impedance ; Esophageal Stenosis/etiology ; Esophageal Stenosis/physiopathology ; Female ; Humans ; Laryngectomy/adverse effects ; Male ; Middle Aged ; Muscle Contraction/physiology ; Pharynx/physiopathology ; Radiotherapy/adverse effects ; Squamous Cell Carcinoma of Head and Neck/therapy
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Grant Information:
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1046882 International National Health and Medical Research Council; International Brian and Pearl Bowles Foundation; International St George and Sutherland Medical Research Foundation
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Contributed Indexing:
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Keywords: dysphagia; intrabolus pressure; manometry; pharynx; stricture
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Substance Nomenclature:
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0 (Antineoplastic Agents)
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Entry Date(s):
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Date Created: 20180526 Date Completed: 20191107 Latest Revision: 20191107
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Update Code:
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20240105
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DOI:
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10.1111/nmo.13374
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PMID:
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29797467
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Introduction: Restrictive defects of the pharyngo-esophageal junction (PEJ) are common in both structural and neurological disorders and are amenable to therapies aiming to reduce outflow resistance. Intrabolus pressure (IBP) acquired with high-resolution manometry and impedance (HRMI) is an indicator of resistance and a marker of reduced PEJ compliance. Constraints and limitations of IBP as well as the optimal IBP parameter remain undefined.
Aims: To determine: (i) the impact of peak pharyngeal pressure (PeakP) on the diagnostic accuracy of IBP for the detection of a restrictive defect at the PEJ and (ii) the optimal IBP parameter for this purpose.
Methods: In 52 dysphagic patients previously treated for head and neck cancer. Five candidate IBP measures and PeakP were obtained with HRMI, as well as a presence of a stricture determined by a mucosal tear after endoscopic dilatation. Predictive values of IBP measures were evaluated by receiver operating characteristic (ROC) analysis for all patients and reiterated as patients with lowest PeakP were progressively removed from the cohort.
Results: All IBP parameters had fair to good accuracy at predicting strictures. Intrabolus pressure measured at a discrete point of maximum admittance 1 cm above the maximal excursion of the upper esophageal sphincter had highest sensitivity (0.76) and specificity (0.78). When PeakP was at least 57 mm Hg both sensitivity and specificity improved to 0.9.
Conclusions: Pharyngeal propulsive force has substantial impact on the accuracy of IBP as a predictor of a PEJ stricture. When PeakP is ≥57 mm Hg, an elevated IBP is highly predictive of a restrictive defect at the PEJ.
(© 2018 John Wiley & Sons Ltd.)
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